name: Monitor patient's hydration status, as appropriate


name: Encourage patient to eat in dining room if available


name: Provide social interaction, as appropriate


name: Use unbreakable and weighted dishes and glasses as necessary


name: Determine needs for safety-related changes in the home (e.g., wider door frames to allow for wheelchair access to bathroom, removal of scatter-rugs)


name: Obtain transportation enhancements to offset disabilities (e.g., hand controls on cars, wide rear-view mirror), as appropriate


name: Obtain tools to assist in daily activities (e.g., ability to reach items in cupboards, in closets, on countertops, on stovetops, and in refrigerator, and ability to operate household equipment such as stoves and microwaves)


name: Verify adequacy of lighting throughout house, especially in working areas (e.g., kitchen, bathroom) and at night (e.g., appropriately placed nightlights)


name: Instruct individual not to smoke in bed, while reclining, or after taking mind-altering medication


name: Verify presence of safety equipment in home (e.g., smoke detectors, carbon monoxide detectors, fire extinguishers, hot water heater set to 120° F)


name: Instruct individual and caregiver on what to do in the event the individual suffers from a fall or other injury (e.g., what to do, how to gain access to emergency services, how to prevent further injury)


name: Determine current ability of patient to transfer self (e.g., mobility level, limitations of movement, endurance, ability to stand and bear weight, medical or orthopedic instability, level of consciousness, ability to cooperate, ability to comprehend instructions)


name: Select transfer technique that is appropriate for patient


name: Instruct patient in all appropriate techniques with the goal of reaching the highest level of independence


name: Instruct individual on techniques for transfer from one area to another (e.g., bed to chair, wheelchair to vehicle)


name: Instruct individual in use of ambulatory aids (e.g., crutches, wheelchairs, walkers, trapeze bars, cane)


name: Make sure equipment works before using it


name: Provide privacy, avoid drafts, and preserve the patient's modesty


name: Use proper body mechanics during movements


name: Keep patient body in proper alignment during movements


name: Raise and move patient with a hydraulic lift as necessary


name: Move patient using a transfer board as necessary


name: Evaluate patient at end of transfer for proper body alignment, nonocclusion of tubes, wrinkled linens, unnecessarily exposed skin, adequate patient level of comfort, raised side rails, and call bell within reach


name: Provide encouragement to patient as he/she learns to transfer independently


name: Explore individual's perception of his/her capability to perform the desired behavior


name: Explore individual's perception of benefits of executing the desired behavior


name: Identify individual's perception of risks of not executing the desired behavior


name: Provide information about the desired behavior


name: Assist individual to commit to a plan of action for changing behavior


name: Reinforce confidence in making behavior changes and taking action


name: Provide an environment supportive to learning knowledge and skills needed to carry out the behavior


name: Use teaching strategies that are culturally and age appropriate (e.g., games, computer-assisted instruction, or conversation maps)


name: Engage in role play to rehearse behavior


name: Provide positive reinforcement and emotional support during the learning process and while implementing the behavior


name: Provide opportunities for mastery experiences (e.g., successful implementation of the behavior)


name: Use positive persuasive statements regarding the individual's ability to carry out the behavior


name: Encourage interaction with other individuals who are successfully changing their behavior (e.g., support group or group education participation)


name: Prepare individual for the physiological and emotional states that may be experienced during initial attempts to carry out a new behavior


name: Encourage patient to engage in self-talk and to verbalize positive affirmations daily to self


name: Assist the patient to cope with bullying or teasing


name: Explore previous achievements of success


name: Assist patient to identify significance of culture, religion, race, gender, and age on self-esteem


name: Instruct parents to recognize children's accomplishments


name: Determine whether the patient is an appropriate candidate for self-hypnosis


name: Utilize self-hypnosis as an adjunct to other treatment modalities (e.g., individual hypnotherapy by a therapist, individual psychotherapy, group therapy, family therapy, etc.)


name: Obtain history of the problem to be treated by self-hypnosis


name: Determine goals for self-hypnosis with patient


name: Determine patient's receptivity about using self-hypnosis


name: Correct myths and misconceptions of self-hypnosis


name: Assist the patient to identify appropriate induction techniques (e.g., Chevreul's pendulum illusion, relaxation, imagining walking down a staircase, eye closure, arm levitation, simple muscle relaxation, visualization exercises, attention to breathing, repetition of key words/phrases, and others)


name: Assist the patient to evaluate progress made toward therapy goals


name: Encourage the patient to examine personal values and beliefs and his or her satisfaction with them


name: Assist the patient in identifying the target behaviors' effects on social and environmental surroundings


name: Assist the patient in identifying the stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination


name: Encourage the patient to identify appropriate, meaningful reinforcers and rewards


name: Encourage the patient to choose a reinforcer or reward that is significant enough to sustain the behavior


name: Foster moving toward primary reliance on self-reinforcement instead of family or nurse for rewards


name: Encourage the patient to adjust the shaping plan to enhance behavior change (e.g., size of steps or reward), if needed


name: Explore with the patient the option of using a technological device in organizing coding sheets, change data, cue analysis, and visual measures of change (e.g., computer, smart phone)


name: Explore with the patient the potential use of imagery, meditation, or progressive relaxation in attempting behavior change


name: Facilitate the patient and family to make choices concerning their care, as appropriate


name: Ensure patients and family members have the appropriate resources to assume more responsibility


name: Provide opportunities for self-evaluation and self-reflection


name: Assist parents in identifying age-appropriate tasks for which a child could be responsible, as appropriate


name: Encourage patient to verbalize fears and to ask questions about sexual functioning


name: Collect the client's sexual history paying close attention to normal patterns of functioning and the terms used by the patient to describe sexual function


name: Determine the duration of sexual dysfunction and potential causes


name: Monitor for stress, anxiety, and depression as possible causes of sexual dysfunction


name: Determine the knowledge level of the patient and understanding about sexuality in general


name: Discuss the effect of the health and illness on sexuality


name: Discuss the effect of medications and supplements on sexuality, as appropriate


name: Discuss the effect of changes in sexuality on significant other


name: Help patient to express grief and anger about alterations in body functioning or appearance, as appropriate


name: Instruct the patient on use of medication(s) and devices to enhance ability to perform sexually, as appropriate


name: Include the significant other in the counseling as much as possible, as appropriate


name: Use humor and encourage patient to use humor to relieve anxiety or embarrassment, being careful to use humor that is appropriate to the situation, tactful, and respectful of patient beliefs and cultural background


name: Draw arterial blood gases and monitor tissue oxygenation


name: Monitor trends in hemodynamic parameters (e.g., CVP, MAP, pulmonary capillary/artery wedge pressure)


name: Monitor determinants of tissue oxygen delivery (e.g., PaO2, SaO2, hemoglobin levels, CO) if available


name: Monitor sublingual carbon dioxide levels and/or gastric tonometry, as appropriate


name: Monitor laboratory values (e.g., CBC with differential, coagulation profile, ABG, lactate level, cultures, and chemistry profile)


name: Administer IV fluid challenge while monitoring hemodynamic pressures and urinary output, as appropriate


name: Administer crystalloid or colloid intravenous fluids, as appropriate


name: Administer packed red blood cells, fresh frozen plasma, and/or platelets, as appropriate


name: Monitor for hyperdynamic state of septic shock post fluid resuscitation (e.g., increased CO, decreased SVR, flushed skin, or increased temperature)


name: Monitor fluid status, including daily weights, hourly urine output, I&O


name: Monitor renal function (e.g., BUN, Cr levels, creatinine clearance)


name: Administer continuous renal replacement therapy or hemodialysis, as appropriate


name: Insert nasogastric tube to suction and monitor secretions, as appropriate


name: Administer recombinant activated protein C, as appropriate


name: Administer low dose vasopressin, as appropriate


name: Administer corticosteroids, as appropriate


name: Administer DVT and stress ulcer prophylaxis, as appropriate


name: Offer emotional support to the patient and family, encouraging realistic expectations


name: Monitor for signs and symptoms of decreased cardiac output


name: Monitor for inadequate coronary artery perfusion (ST changes on EKG, elevated cardiac enzymes, angina), as appropriate


name: Monitor and evaluate indicators of tissue hypoxia (mixed venous oxygen saturation, central venous oxygen saturation, serum lactate levels, sublingual capnometry)


name: Administer supplemental oxygen, as appropriate


name: Maintain optimal preload by administering IV fluids or diuretics, as appropriate


name: Prepare patient for cardiac revascularization (percutaneous coronary intervention or coronary artery bypass graft)


name: Administer positive inotropic/contractility medications, as appropriate


name: Promote optimal preload while minimizing afterload (e.g., administer nitrates while maintaining pulmonary artery occlusion pressure within prescribed range), as appropriate


name: Promote adequate organ system perfusion (with fluid resuscitation and/or vasopressors to maintain mean arterial pressure greater than or equal to 60 mm Hg, as appropriate


name: Monitor for physiological changes related to loss of vascular tone (e.g., note decreased BP, bradycardia, tachypnea, reduced pulse pressure, anxiety, oliguria)


name: Consider Trendelenburg position if head injury has been ruled out


name: Administer high flow oxygen, as appropriate


name: Administer epinephrine via SQ, IV, or ET routes for anaphylaxis, if appropriate


name: Assist in early endotracheal intubation, as appropriate


name: Administer atropine for bradycardia, as appropriate


name: Utilize transcutaneous pacing, as appropriate


name: Monitor pneumatic antishock garment, as appropriate


name: Maintain two large-bore intravascular access sites


name: Administer isotonic crystalloids as bolus doses, keeping systolic pressure at 90 mm Hg or more, as appropriate


name: Administer antihistamine and/or corticosteroid, as appropriate


name: Treat overdoses with appropriate reversal agent


name: Insert NG tube and administer charcoal lavage, as appropriate


name: Monitor trends in hemodynamic parameters (e.g., CVP, MAP, PAWP, or PCWP wedge pressure)


name: Administer antiinflammatory medications, as appropriate


name: Avoid stimuli that will precipitate neurogenic reaction (e.g., skin stimulation, distended bladder, or constipation)


name: Monitor for sudden loss of blood, severe dehydration, or persistent bleeding


name: Check all secretions for frank or occult blood


name: Monitor for fall in systolic blood pressure to less than 90 mm Hg or a fall of 30 mm Hg in hypertensive patients


name: Monitor sublingual carbon dioxide levels


name: Monitor for signs/symptoms of hypovolemic shock (e.g., increased thirst, increased HR, increased SVR, decreased urine output, decreased bowel sounds, decreased peripheral perfusion, altered mental status, or altered respirations)


name: Administer IV fluids such as isotonic crystalloids or colloids, as appropriate


name: Administer warmed IV fluids and blood products, as indicated


name: Administer blood products (e.g., packed red blood cells, platelets, or fresh frozen plasma), as appropriate


name: Monitor laboratory studies (e.g., serum lactate, acid-base balance, metabolic profiles, and electrolytes)


name: Monitor for early compensatory shock responses (e.g., normal blood pressure, narrowed pulse pressure, mild orthostatic hypotension [15 to 25 mm Hg], slight delayed capillary refill, pale/cool skin or flushed skin, slight tachypnea, nausea and vomiting, increased thirst, or weakness)


name: Monitor for early signs of systemic inflammatory response syndrome (e.g., increased temperature, tachycardia, tachypnea, hypocarbia, leukocytosis, or leucopenia)


name: Monitor for early signs of cardiac compromise (e.g., declining CO and urinary output, increasing SVR and PCWP, crackles in the lungs, S3 and S4 heart sounds, and tachycardia)


name: Monitor possible sources of fluid loss (e.g., chest tube, wound, and nasogastric drainage; diarrhea; vomiting; and increasing abdominal and extremity girth, hematemesis, or hematochezia)


name: Monitor for signs of inadequate tissue oxygenation (e.g., apprehension, increased anxiety, changes in mental status, agitation, oliguria, and cool, mottled periphery)


name: Monitor daily weights, intake, and output


name: Monitor laboratory values, especially Hgb and Hct levels, clotting profile, ABG, lactate level, electrolyte levels, cultures, and chemistry profile


name: Monitor invasive hemodynamic parameters (e.g., CVP, MAP, and central/mixed venous oxygen saturation), as appropriate


name: Monitor sublingual CO2 or gastric tonometry, as appropriate


name: Test urine for blood, and protein, as appropriate


name: Monitor for signs/symptoms of ascites and abdominal or back pain


name: Place patient in supine, legs elevated position (volume, vasogenic) or supine, head and shoulders elevated (cardiogenic), as appropriate


name: Insert and maintain large-bore IV access, as appropriate


name: Administer antiarrhythmics, diuretics, and/or vasopressors, as appropriate


name: Monitor blood glucose and administer insulin therapy, as appropriate


name: Administer IV, intraosseous, or endotracheal epinephrine, as appropriate


name: Advise patients at risk to wear or carry medical alert information


name: Assist sibling to maintain and/or modify usual routines and activities of daily living as necessary


name: Assist parents to be fair in terms of discipline, resources, and attention


name: Teach sibling strategies for meeting own emotional and developmental needs


name: Communicate situation to the school nurse to promote support for younger sibling in accord with parental wishes


name: Verify that a complete history and physical have been obtained before skin graft surgery


name: Cover donor site for skin autografts postoperatively with an alginate and a transparent, semiocclusive dressing, as per agency protocol


name: Inspect the dressing daily, as per agency protocol


name: Apply dressings made of cotton or gauze to maintain adequate tension on the graft site, as per agency protocol


name: Elevate graft site until graft-host circulation develops (approximately 1 week); then allow the graft site to be in a dependent position for progressively longer periods of time, per agency protocol


name: Utilize needle aspiration to evacuate fluids from beneath the graft in order to maintain close contact between the recipient bed and the graft during the postoperative revascularization period


name: Monitor color, warmth, capillary refill, and turgor of graft, if not dressed


name: Instruct patients to regularly apply artificial lubrication to graft site as necessary


name: Instruct patient that protection of graft site may be necessary for years after the graft


name: Inspect skin daily for those at risk of breakdown


name: Inspect skin and mucous membranes for redness, extreme warmth, edema, or drainage


name: Use an assessment tool to identify patients at risk for skin breakdown (e.g., Braden Scale)


name: Monitor skin and mucous membranes for areas of discoloration, bruising, and breakdown


name: Document skin or mucous membrane changes


name: Institute measures to prevent further deterioration (e.g., overlay mattress, repositioning schedule)


name: Facilitate maintenance of patient's usual bedtime routines, presleep cues/props, and familiar objects (e.g., for children-a favorite blanket/toy, rocking, pacifier, or story; for adults-a book to read, etc.), as appropriate


name: Provide pamphlet with information about sleep-enhancement techniques


name: Help choose best method for giving up cigarettes when patient is ready to quit


name: Help motivated patients to set a quit date


name: Advise to avoid smokeless tobacco, dipping, and chewing as these can lead to addiction and/or health problems, including oral cancer, gum problems, loss of teeth, and heart problems


name: Follow patient for 2 years after quitting to provide encouragement, if possible


name: Help patient deal with any lapses (e.g., reassure patient that he/she is not a "failure"; reassure that much can be learned from this temporary regression; and assist patient in identifying reasons for the relapse)


name: Support patient who begins smoking again by helping identify what has been learned


name: Maintain focus on the target audience through all activities


name: Cultivate partnerships with the target audience and appropriate professionals


name: Identify the overall goal to be achieved in collaboration with the target audience


name: Identify the key formal, social, and governmental groups involved


name: Conduct a needs assessment of the environment, identifying target audience desires


name: Conduct organization or group assessment


name: Identify appropriate quantitative and qualitative research to provide information, support, and indicators of success


name: Design a plan of action based on mutually agreed-upon goals


name: Nurture the voluntary basis of the planned social change


name: Identify the product (behavior change), the price (consumer's actions), and the place (how the product reaches the consumer)


name: Consider the financial resources necessary and available


name: Identify specific activities for each goal, including naming of appropriate participants


name: Implement the plan in collaboration with the target population


name: Control the plan through monitoring of assigned tasks


name: Provide appropriate reports on a timely basis


name: Evaluate the plan for achievement of goals with consideration of sustainability and affordability


name: Promote relationships with persons who have common interests and goals


name: Promote sharing of common problems with others


name: Promote involvement in totally new interests


name: Facilitate the use of sensory deficit aids, such as eyeglasses and hearing aids


name: Encourage participation in group and/or individual reminiscence activities


name: Facilitate patient participation in storytelling groups


name: Apply special specimen collection devices for infants, toddlers, or impaired adults, as needed


name: Label specimen with appropriate data before leaving the patient


name: Demonstrate caring presence and comfort by spending time with patient, patient's family/significant other(s)


name: Refer to support groups, mutual self-help, or other spiritually based programs, as appropriate


name: Use therapeutic communications to establish trust and empathic caring


name: Arrange visits by individual's spiritual advisor


name: Provide spiritual music, literature, or radio or television programs to the individual


name: Monitor circulation (e.g., pulse, capillary refill, and sensation) in injured body part


name: Cover open wound with dressing and control bleeding before applying splint


name: Minimize movement of patient, especially injured body part


name: Identify most appropriate splint material (e.g., rigid, soft, anatomical, or traction)


name: Immobilize joint above and joint below injury site


name: Place injured hand or wrist in position of function


name: Apply splint in position injured body part is found, using hands to support injury site, minimizing movement, and using the assistance of another health care team member when possible


name: Instruct patient or family how to care for the splint


name: Encourage general fitness as prerequisite to sport participation


name: Assist athlete in finding a sport that is a good fit with interests and abilities and will promote the development of lifelong fitness behaviors


name: Monitor sports physicals to insure they are complete before participation


name: Encourage use of warm up and cool down activities to prevent injuries


name: Inform parents and athletes of signs and symptoms of overuse injuries, dehydration, heat exhaustion, use of performance enhancing drugs, eating disorders, menstrual dysfunction, and stress


name: Assure coaches are well informed of normal childhood development and the physical, emotional, and social needs of children


name: Design methods of preassessment, postassessment, and evaluation


name: Ensure that staff members provide care within their approved scopes of practice


name: Ensure that staff members have current licensure, as appropriate


name: Incorporate understanding of generational differences when assigning and evaluating work


name: Initiate disciplinary action, as appropriate, adhering to policies and procedures


name: Ensure the product to be infused has been prepared, labeled, and classified according to institution protocol


name: Explain the procedure and the aim of the infusion of hematopoietic stem cells to patients and caregivers


name: Inform the patient and the family about the possible negative effects (e.g., transfusion reaction, volume overload, pulmonary embolism, changes in vital signs, and nausea/vomiting) that may appear during infusion


name: Use peppermint oil or hard candy to counteract the offensive smell and taste of preservative


name: Prepare infusion equipment without filter and other necessary materials (e.g., physiological serum 0.9%, venous pressure measurement systems, sphygmomanometer, phonendoscope, thermometer, and pulsometer)


name: Verify that the infusion equipment has no filter and no infusion pumps to avoid cellular damage


name: Use saline solution to flush the equipment


name: Prepare emergency material and drugs to treat serious negative reactions, including anaphylaxis kit, oxygen administration equipment, and suction equipment


name: Use gloves during the manipulation of the infusion product


name: Ensure aseptic manipulation of equipment, connections, and product


name: Administer prehydration solution according to the protocol


name: Coordinate immediate administration of the defrosted infusion product


name: Administer premedication prescribed according to the protocol of the institution


name: Avoid irradiation and any type of mechanical or physical damage to the infusion product


name: Make sure that the infusion product is received in optimal isolation and refrigeration conditions (1° to 24° C)


name: Verify the labeling and the identification of both the bags and the patient (using patient name and hospital number) immediately before infusion


name: Administer the infusion through a central venous catheter through the largest lumen available for ease of flow


name: Infuse each bag at the rate, sequence, and time established in the protocol guidelines of the institution and according to the tolerance of the patient


name: Monitor for possible adverse reactions (e.g., nausea, vomiting, abdominal cramps, diarrhea, facial flare, arrhythmia, dyspnea) and stop the infusion and call the physician, if necessary


name: Irrigate the infusion catheter with saline solution after the infusion of each bag


name: Irrigate the intravenous line with saline solution if syringes were used to infuse the product in order to reduce the loss of stem cells that could remain in the lumen of the catheter or infusion system


name: Dispose of spare material and hazardous waste according to agency protocol


name: Monitor vital signs according to institutional protocol during and after the procedure


name: Record volume of stem cells and normal saline administered


name: Monitor the elimination of urine, paying attention to volume, color, and osmolality


name: Observe for signs and symptoms of circulatory overload


name: Record the patient's response (e.g., tolerance and negative effects) according to the protocol of the institution


name: Document adverse events according to agency protocol


name: Bed rest with bedside commode, as appropriate


name: Restrict television, radio, and other stimulants


name: Provide information to patient and family regarding need for environmental modifications and visiting limitations


name: Notify physician of neurological deterioration


name: Monitor CSF output and characteristics, if indicated


name: Instruct patient not to strain or perform Valsalva maneuver


name: Foster a trusting relationship while setting clear limits (i.e., provide gentle but firm evidence of dysfunction, stay focused on substance abuse or dependency, and inspire hope)


name: Consider presence of comorbidity, or cooccurring psychiatric or medical disorder, making changes in treatment accordingly


name: Assist patient in understanding disorder as a disease related to several factors (e.g., genetic, psychological, and situational circumstances)


name: Inform patient that the volume and frequency of substance use leading to dysfunction varies greatly between people


name: Instruct patient on effects of substance used (e.g., physical, psychological, and social)


name: Discuss treatment needs for associated medical, psychological, social, vocational, housing, and legal difficulties


name: Encourage or praise patient efforts to accept responsibility for substance use-related dysfunction and treatment


name: Administer medications (e.g., disulfiram, acamprosate, methadone, naltrexone, nicotine patches or gum, or buprenorphine), as indicated


name: Instruct patient or family about medications used for treatment


name: Provide therapy (e.g., cognitive therapy, motivational therapy, counseling, family support, family therapy, or adolescent community reinforcement approach), as indicated


name: Establish multidisciplinary programs (e.g., short-term inpatient residential therapy, detoxification program, or residential therapeutic community treatment), if appropriate


name: Encourage patient to participate in self-help support program during and after treatment (e.g., 12-step programs, Women for Sobriety, or Rational Recovery)


name: Discuss importance of abstaining from substance use, identifying most appropriate treatment goal (e.g., complete abstinence, day-by-day sobriety, or use of substance in moderation)


name: Coordinate and facilitate group confrontation strategy to address use of and role defenses play in substance use (e.g., denial)


name: Instruct patient on stress management techniques (e.g., exercise, meditation, and relaxation therapy)


name: Assist patient in developing healthy, effective coping mechanisms


name: Identify and address dysfunctional relationship patterns in patient's familial or other social ties (e.g., codependency and enabling)


name: Assist in identifying and facilitating connections with supportive persons


name: Assist in resocialization, rebuilding relationships, and decreasing self-centeredness


name: Monitor for substance use during treatment (e.g., urine screens and breath analysis)


name: Monitor for infectious disease (e.g., HIV/AIDS, hepatitis B and C, and tuberculosis), treating and providing assistance to modify behaviors, if necessary


name: Assist patient in developing self-worth, encouraging positive efforts and motivation


name: Participate in efforts to remain abreast of available programs, resources, and legislation aimed at education, prevention, and treatment of substance use disorders


name: Instruct patient on symptoms or behaviors that increase chances of relapse (e.g., exhaustion, depression, dishonesty, and complacency)


name: Develop plan for relapse prevention (e.g., contracting, identify resources for various needs in stressful situation, and identify health promoting activities to take place of substance use)


name: Instruct family on substance use disorder and related dysfunction and include in treatment planning and activities


name: Encourage family to participate in recovery efforts


name: Monitor respiratory and cardiac systems (e.g., hypertension, tachycardia, and bradypnea)


name: Monitor for changes in level of consciousness


name: Implement precautions for patient at risk for suicide


name: Monitor withdrawal symptoms (e.g., fatigue, sensory disturbances, irritability, violence, depression, panic attacks, cravings, insomnia, agitation, muscle pain, appetite changes, yawning, weakness, headache, runny nose, dilated pupils, chills, anxiety, sweating, nausea, vomiting, tremors, psychosis, and ataxia)


name: Administer medications (e.g., benzodiazepines, chlorpromazine, diazepam, nicotine replacement, phenobarbital, clonidine, trazodone, methadone, alpha-2 adrenergic agonists, and antipsychotics), remaining aware of cross-tolerance


name: Implement precautions for patient at risk for seizures


name: Provide adequate nutrition (e.g., small amounts of fluids frequently and high-calorie foods)


name: Implement precautions for patient at risk for falling


name: Maintain low-stimulation environment (e.g., talk in a low, calm voice; provide reassurance about safety; and ensure a comfortable, darkened, quiet, and nonthreatening environment)


name: Encourage patient to participate in follow-up support (e.g., peer group therapy, individual or family counseling, and drug recovery educational programs)


name: Offer supportive assistance (e.g., provision of food and shelter, structured psychotherapy)


name: Facilitate support by family and significant others


name: Instruct patient and family on process of drug use and dependency


name: Monitor respiratory, cardiac, gastrointestinal, renal, and neurological status


name: Place patient in most appropriate position (e.g., semi-Fowler's position if patient is awake; left lateral recumbent position if patient is unresponsive)


name: Provide safe environment (i.e., pad side rails, keep bed in lowest position, remove dangerous objects, and position safety officer near patient's room)


name: Establish rapport with patient or family (i.e., use nonjudgmental approach; do not reprimand)


name: Perform necessary toxicology screening and system function tests (e.g., urine and serum drug screening, arterial blood gases, electrolyte levels, liver enzymes, blood urea nitrogen, and creatinine)


name: Contact poison control center for assistance in determining definitive treatment


name: Establish intravenous access, administering infusions as prescribed


name: Monitor for symptoms specific to drug consumed (e.g., constricted pupils, hypotension, and bradycardia for opiate overdose; nausea, vomiting, diaphoresis, and right upper quadrant pain 48 to 72 hours after acetaminophen overdose; and dilated pupils, tachycardia, seizures, and chest pain for cocaine overdose)


name: Administer agents specific to substance consumed and patient symptoms (e.g., antiemetics, naloxone, thiamine, glucose, flumazenil, calcium, vasopressors, antiarrhythmics, and inotropics


name: Administer agents or perform procedures to impair drug absorption and increase drug excretion (e.g., ipecac, activated charcoal, gastric lavage, hemodialysis, cathartics, exchange transfusion, altering urine and serum pH, and whole-bowel irrigation)


name: Communicate with patient, providing reassurance, addressing hallucinations or delusions, and conveying understanding of fears or other feelings


name: Treat hyperthermia (i.e., apply ice packs for fever caused by amphetamine or cocaine intoxication)


name: Provide instruction on proper use of drug


name: Assist patient in identifying ways to minimize potential for accidental overdose (e.g., store medications in original container, address issues with confusion or memory, and store medications out of children's reach)


name: Instruct family or caregiver on patient's need for follow-up care


name: Instruct family or caregiver on aspiration and seizure precautions


name: Provide referral (e.g., home health agency, social worker, psychiatry, or drug use treatment program)


name: Determine whether patient has available means to follow through with suicide plan


name: Advocate for quality of life and pain control issues


name: Conduct mouth checks after medication administration to ensure that patient is not "cheeking" the medications for later overdose attempt


name: Provide small amounts of prescriptive medications that may be lethal to those at risk to decrease the opportunity for suicide, as appropriate


name: Utilize direct, nonjudgmental approach in discussing suicide


name: Avoid repeated discussion of past suicide history by keeping discussions focused on the present and the future


name: Discuss plans for dealing with suicidal ideation in the future (e.g., precipitating factors, who to contact, where to go for help, ways to alleviate feelings of self-harm)


name: Explain suicide precautions and relevant safety issues to the patient/family/significant others (e.g., purpose, duration, behavioral expectations, and behavioral consequences)


name: Refer patient to mental health care provider (e.g., psychiatrist or psychiatric/mental health advanced practice nurse) for evaluation and treatment of suicide ideation and behavior, as needed


name: Work with physicians and others to standardize the specifications for products and reduce total number of supplies


name: Assist in the automation and upkeep of the inventory list to avoid overstocking and overspending


name: Coordinate purchases with other departments to reduce costs, as appropriate


name: Work with suppliers and vendors to ensure best product at lowest cost, as needed


name: Have supplies shipped directly to patient's home, as appropriate


name: Review supply budget and inventory costs, as appropriate


name: Participate in the value analysis process to determine whether it is the "right product" at the "right price"


name: Participate in the governing agency's integrated supply chain management process, as appropriate


name: Understand how the use of GS1 Global Traceability Standard to identify items and locations can improve patient safety and reduce costs of supplies


name: Determine the most appropriate venue for the group's meeting (e.g., face to face or online)


name: Identify faith-based groups as available options for clients, as appropriate


name: Use a written contract if deemed appropriate


name: Form a group of optimal size (e.g., 5 to 12 members)


name: Schedule a limited number of sessions (e.g., 6 to 12) in which the work of the group will be accomplished


name: Assist the group to progress through the stages of group development, from orientation through cohesiveness to termination


name: Refer the patient to other specialist, as appropriate


name: Identify psychological response to situation and availability of support system


name: Identify degree of family support, financial support, and other resources


name: Determine barriers to unused and underused support systems


name: Monitor current family situation and the support network


name: Refer to a self-help group or Internet-based resource, as appropriate


name: Identify community resource strengths and weaknesses and advocate for change, when appropriate


name: Refer to a community-based prevention or treatment program, as appropriate


name: Involve family/significant other(s) and friends in the care and planning


name: Identify available resources for caregiver support


name: Perform surgical hand antisepsis in accordance with the hospital protocol or rules


name: Don a sterile gown and gloves using aseptic technique


name: Assist the surgical team while they don gown and gloves


name: Adopt a position that allows you to keep the surgical field in sight throughout the surgery


name: Ensure that appropriate instruments, supplies, and equipment are sterile and in good working order


name: Transfer the scalpel or dermatographic pencil to the surgeon, as appropriate


name: Provide the instruments in an appropriate safe manner


name: Maintain the sterility of the surgical field throughout the procedure, disposing of contaminated elements, and taking measures to preserve surgical integrity and asepsis


name: Remove soiled sponges and deposit them in an appropriate place, replacing them with clean ones


name: Clean the incision site and drains of blood, secretions, and residual skin antiseptic


name: Assist in the closing of the surgical wound


name: Dry the skin at the incision site and drains


name: Apply reinforcement bands, dressings, or bandages to the surgical wound


name: Connect the drains to their collection systems, attach them, and keep them in the appropriate position


name: Assist in transferring patient to the cart or bed and transport to appropriate postanesthesia or postoperative area


name: Document information, as per agency policy


name: Consult surgical schedules, check operating room assignments, and obtain information on the surgical procedure and anesthetic technique


name: Change into the scrubs, footwear, cap, and mask specific to the surgical area before entering the operating room


name: Place tables containing instruments and equipment in the appropriate areas


name: Keep sharp and pointed objects (e.g., scalpel blades and needles) separate from other objects in order to avoid injuries during preparation


name: Verify the safety and proper operation of the equipment and instruments required for patient care (e.g., surgical table, perfusion pumps, temperature regulating equipment, electric scalpels)


name: Obtain the sterile supplies and materials appropriate to the surgery, observing aseptic technique


name: Confirm the integrity of the packages or wrappings, expiration dates, and sterility controls, and follow the traceability of the materials in keeping with hospital regulations


name: Prepare the consumable clothing and supplies appropriate to the type of surgery


name: Drape the instrument tables, Mayo tables, and auxiliary tables with sterile cloth or impermeable fields, as appropriate


name: Establish a safety perimeter around the tables and materials with regard to other professional and nonsterile areas


name: Provide towels/pads for the surgical team to dry their hands on


name: Secure devices in the surgical field (e.g., cables, circuit cameras, aspirators)


name: Remove instruments and supplies from the surgical table once the surgery is finished


name: Remove field forceps, aspirator tube, electric scalpel, and other elements from the surgical field after the conclusion of the operation


name: Roll up the fields, sheets, and surgical drapes used in the surgery, avoiding the spread and contamination of the air, and dispose of them in an appropriate container


name: Remove scalpel blades from their handles, needles, sharp and pointed objects and deposit them in appropriate containers


name: Separate the clean materials and instruments from the dirty or highly contaminated ones to facilitate cleaning, disinfection, and later sterilization


name: Coordinate and assist in the cleaning and preparation of the operating room for the next patient (i.e., collect and put away machines, supports, and other supplies)


name: Arrange the oxygenation and artificial ventilation equipment and material (e.g., laryngoscopes, tubes, aspirator, masks, Magill forceps, stiffening wires, phonendoscope)


name: Monitor the accessories specific to the required surgical position (e.g., supports, stirrups, fasteners)


name: Participate in a preoperative briefing with others, as per agency policy


name: Welcome the patient, establishing a relationship of trust and offering counsel


name: Ask patient or appropriate other to state patient's name and birth date


name: Participate in the preoperative "time out" to verify correct patient, procedure, and site, as per agency policy


name: Assist in the transfer of the patient to the surgical table while monitoring devices


name: Preserve the patient's privacy, avoiding unnecessary exposure or chills


name: Count sponges, sharps, and instruments before, during, and after surgery, as per agency policy


name: Record results of counts, as per agency policy


name: Provide a sterile container for depositing sharp objects


name: Verify that prep solutions are nonflammable or that flammable prep agents have evaporated before draping


name: Remove residual flammable prep agents before the start of surgery


name: Evacuate oxygen from under surgical drapes


name: Take precautions before the surgery starts against ionizing radiation or use protective equipment in situations that require it


name: Deposit waste materials in the appropriate containers


name: Assist in the transfer of the patient, verifying the proper position of tubes, catheters, and drains, and adopting the position appropriate to the surgery performed


name: Cover the patient to avoid unnecessary exposure and loss of heat


name: Participate in a postoperative debriefing, as per agency policy


name: Identify patient's level of anxiety or fear concerning the surgical procedure


name: Ensure that a completed history and physical is recorded in the chart


name: Assure that the surgical site is marked with a permanent marker by the surgeon, as indicated


name: Involve the patient in marking the surgical site, as indicated


name: Verify that the required laboratory and diagnostic test results are in the chart


name: Verify that an ECG has been completed, as appropriate


name: Communicate special care considerations such as blindness, hearing loss, or handicap to operating room staff, as appropriate


name: Remove jewelry and tape rings in place, as appropriate


name: Remove dentures, glasses, contacts, or other prostheses, as appropriate


name: Send required medications or equipment with patient to the operating room, as appropriate


name: Administer surgical shave, scrub, shower, enema, or douche, as appropriate


name: Instruct patient to void immediately before preoperative medications, as appropriate


name: Check that patient is in proper attire based on institutional policy


name: Support patient with high anxiety or fear level


name: Assist patient onto cart for transport, as appropriate


name: Provide time for family members to speak with patient before transport


name: Encourage parents to accompany child to the operating room, as appropriate


name: Prepare room for patient's return postoperative


name: Ask patient for her or his perception of health status


name: Select appropriate patient indices for ongoing monitoring based on patient's condition


name: Determine presence of patient trigger areas for immediate response (e.g., change in vital signs, low or elevated heart rate, low or elevated blood pressure, difficulty breathing, low oxygen saturation despite increasing oxygen delivery, change in level of consciousness, repeated or prolonged seizures, chest pain, acute changes in mental status, or when nurse or patient "just feels something is wrong")


name: Activate the rapid response team if indicated by presence of trigger areas, per agency protocol


name: Establish the frequency of data collection and interpretation as indicated by status of the patient


name: Monitor unstable or critically ill stable patients (e.g., patients who require frequent neurological assessments, patients experiencing cardiac dysrhythmias, patients receiving continuous intravenous infusions of medications such as nitroglycerine or insulin)


name: Involve patient and family in monitoring activities, as appropriate


name: Institute appropriate treatment, using standing protocols


name: Provide proper environment for desirable patient outcomes (e.g., match nurse competency to patient care needs, provide required patient to nurse ratio, provide adequate auxiliary staffing, ensure continuity of care)


name: Collect data related to health events, such as diseases and injuries, to be reported


name: Determine maternal-fetal health risks through patient interview


name: Monitor behavior of patient and support person


name: Implement electronic fetal monitoring, as appropriate


name: Retrieve and interpret laboratory data and contact physician, as appropriate


name: Initiate interventions for IV therapy, fluid resuscitation, and medication administration, as needed


name: Perform speculum examination for diagnosis of spontaneous rupture of amniotic membranes unless there is evidence of frank bleeding


name: Prioritize actions based on patient status (e.g., treat, continue to observe, admit, or discharge)


name: Interpret results of diagnostic indicators such as vital signs, glucose readings, ECGs


name: Collaborate/consult with physician resources as necessary


name: Initiate skin surveillance in high-risk patient when high resolution video monitoring in use


name: Coordinate placement/replacement/set-up of equipment/supplies


name: Compare current status with previous status to detect improvements and/or deterioration in patient's condition


name: Initiate and/or change medical treatment to maintain patient parameter with the limits ordered by the physician, using established guidelines


name: Determine need and establish time intervals for further intermittent assessment


name: Inform individual/families about how to access local food pantries and free lunch programs


name: Inform about rental laws and protections


name: Arrange for individual/families transportation to job services, if necessary


name: Assist individual/families to complete forms for assistance, such as forms for housing and financial aid


name: Identify patient allergies to anesthetics, suture materials, sterile adhesive strips, tape, and povidone-iodine or other topical solutions


name: Shave hair from the immediate wound site using proper technique


name: Use sterile technique during suture procedure


name: Select an appropriate gauge suture needle and suturing material


name: Pull the suture tight enough to avoid buckling the skin


name: Apply sterile adhesive strips to enhance wound closure (e.g., place perpendicular to incision line; place across suture ends to prevent slippage or excessive pulling), as appropriate


name: Cleanse the sutured area before applying an antiseptic or dressing


name: Instruct patient concerning care of the suture line or sterile adhesive strips, including signs and symptoms of infection


name: Instruct patient on sutures or sterile adhesive strips removal


name: Remove sutures within 1 to 2 weeks of their placement, depending on the anatomical location (on the face, remove in 5 to 7 days; on the neck, 7 days; on the scalp, 10 days; on the trunk and upper extremities, 10 to 14 days; and on the lower extremities, 14 to 21 days), as indicated


name: Use proper technique in removing sutures (i.e., gently elevate with forceps, cut, grasp by knot pull toward suture line)


name: Remove distractions from environment before working with patient on swallowing


name: Assist to maintain sitting position for 30 minutes after completing meal


name: Monitor for signs of fatigue during eating, drinking, and swallowing


name: Instruct patient/caregiver on nutritional requirements and dietary modifications in collaboration with dietician


name: Explore with patients what they have already done to manage the symptoms


name: Recommend toe nail and callus trimming by a specialist, as appropriate


name: Determine capacity to carry out foot care, (e.g., visual acuity, physical mobility, and judgment)


name: Recommend assistance of a significant other with foot care if vision impaired or if there are problems with mobility


name: Instruct to use a mirror or the assistance of another to carry out foot inspection, as needed


name: Recommend daily washing of feet using warm water and mild soap


name: Advise regarding when it is appropriate to contact a health professional, including the presence of a nonhealing or infected lesion


name: Instruct on proper technique for toenail trimming, (i.e., cutting relatively straight across, following the contour of the toe, and filing sharp edges with an emery board)


name: Instruct on care of soft calluses, including gentle buffing with a towel or pumice stone after a bath


name: Recommend specialist care for thick fungal or ingrown toenails, corns, or calluses, as indicated


name: Describe appropriate socks, (i.e., absorbent material and nonconstricting)


name: Recommend guidelines to be followed when purchasing new shoes, including having feet properly measured and fitted at the time of purchase


name: Recommend wearing new shoes only for a few hours at a time for the first 2 weeks


name: Instruct to inspect inside shoes daily for foreign objects, nail points, torn linings, and rough areas


name: Instruct to change shoes two times, (e.g., 12 noon and 5 p.m.) each day to avoid local repetitive pressure


name: Caution about activities that cause pressure on nerves and blood vessels, including elastic bands on socks or crossing legs


name: Include the family/significant other(s) in instruction, as appropriate


name: Coordinate resources within the facility to form a planning/advisory committee, which can contribute to positive outcomes for the program and provide a forum for ensuring commitment to the program


name: Revise teaching strategies/learning activities to increase learning, if necessary


name: Communicate evaluation of the program's goal attainment to the planning/advisory committee


name: Refer the patients to other specialists/agencies to meet the learning objectives, as appropriate


name: Determine the patient's ability to learn specific information (e.g., developmental level, physiological status, orientation, pain, fatigue, unfulfilled basic needs, emotional state, and adaptation to illness)


name: Determine the patient's motivation to learn specific information (e.g., health beliefs, past noncompliance, bad experiences with health care or learning, and conflicting goals)


name: Refer the patient to other specialists or agencies to meet the learning objectives, as appropriate


name: Instruct parent/caregiver to feed only breast milk or formula for first year (no solids before 4 months)


name: Instruct parent/caregiver to always hold infant when giving bottle


name: Instruct parent/caregiver to never prop bottle or give bottle in bed


name: Instruct parent/caregiver to avoid putting cereal in bottle (only formula or breast milk)


name: Instruct parent/caregiver to limit water intake to oz to 1 oz at a time, 4 oz daily


name: Instruct parent/caregiver to avoid use of honey or corn syrup


name: Instruct parent/caregiver to allow nonnutritive sucking


name: Instruct parent/caregiver to discard leftover formula and clean bottle after every feeding


name: Instruct parent/caregiver to introduce solids (pureed) without added salt or sugar


name: Instruct parent/caregiver to introduce iron-fortified infant cereal


name: Instruct parent/caregiver to introduce one new food at a time


name: Instruct parent/caregiver to avoid giving juice or sweetened drinks


name: Instruct parent/caregiver to feed from a spoon only


name: Instruct parent/caregiver to introduce finger foods when infant can sit up


name: Instruct parent/caregiver to introduce cup when infant can sit up


name: Instruct parent/caregiver to have infant join family at meal times


name: Instruct parent/caregiver to let infant begin self-feedings and observe to avoid choking


name: Instruct parent/caregiver to offer fluids after solids


name: Instruct parent/caregiver to avoid sugary desserts and soda


name: Instruct parent/caregiver to offer a variety of foods according to the food pyramid


name: Instruct parent/caregiver to introduce limited amounts of diluted juice in a cup


name: Instruct parent/caregiver to offer three meals and healthy snacks


name: Instruct parent/caregiver to begin to wean from bottle


name: Instruct parent/caregiver to avoid fruit drinks and flavored milk


name: Instruct parent/caregiver to begin table foods


name: Instruct parent/caregiver to allow infant to feed self with a spoon


name: Instruct parent/caregiver to install and use car seat according to manufacturer's recommendations


name: Instruct parent/caregiver to place infant on back to sleep and keep loose bedding, pillows, and toys out of crib


name: Instruct parent/caregiver to use only cribs that are safe


name: Instruct parent/caregiver to avoid use of jewelry or cords/chains on infant


name: Instruct parent/caregiver to use and maintain all equipment properly (e.g., swings, strollers, playpens, port-a-cribs)


name: Instruct parent/caregiver to avoid holding infant while smoking or drinking hot liquids


name: Instruct parent/caregiver to hold infant when feeding, avoid propping of bottle, and test formula temperature


name: Instruct parent/caregiver to monitor experienced/trained childcare providers


name: Instruct parent/caregiver how to prevent falls


name: Instruct parent/caregiver to test water temperature of bath


name: Instruct parent/caregiver to keep pets a safe distance from infant


name: Instruct parent/caregiver never to shake, toss, or swing infant in the air


name: Instruct parent/caregiver to avoid use of walkers or jumpers due to danger of injury and detrimental effects on muscle development


name: Instruct parent/caregiver never to leave infant unattended in the bath, grocery cart, high chair, on sofa, etc


name: Instruct parent/caregiver to evaluate hanging crib toys


name: Instruct parent/caregiver to use a safe high chair when infant is able to sit


name: Instruct parent/caregiver to feed only soft or mashed foods


name: Instruct parent/caregiver to remove small objects from infant's reach


name: Instruct parent/caregiver to avoid sources of lead poisoning


name: Instruct parent/caregiver to keep dangerous items out of infant's reach


name: Instruct parent/caregiver to provide barriers to dangerous areas


name: Instruct parent/caregiver to supervise infant's activity at all times


name: Instruct parent/caregiver to provide protection from glass furniture, sharp edges, unstable furniture, and appliances


name: Instruct parent/caregiver to store all cleaning supplies, medications, and personal care products out of infant's reach


name: Instruct parent/caregiver to use childproof latches on cupboards


name: Instruct parent/caregiver to prevent infant's access to upper story windows, balconies, and stairs


name: Instruct parent/caregiver to keep infant away from ponds, pools, toilets, and all containers with liquid to prevent drowning


name: Instruct parent/caregiver to select toys according to manufacturer's age recommendations


name: Instruct parent/caregiver to ensure multiple barriers to pool/hot tub area


name: Instruct parents to promote face-to-face interaction with infant


name: Instruct parents to talk, sing, and smile at infant while giving care


name: Instruct parents to praise infant for all efforts to respond to stimulation


name: Instruct parents to tell infant his or her name frequently


name: Instruct parents to encourage touching and hugging infant frequently


name: Instruct parents to respond to crying by holding, rocking, singing, talking, walking, repositioning, rubbing/massaging back, and wrapping, as appropriate


name: Instruct parents to rock infant in either an upright position or cradle position


name: Instruct parents to sponge or tub bathe using various massaging strokes with a soft wash cloth or sponge and pat dry with soft towel


name: Instruct parents to massage infant by rubbing lotion in gentle but firm strokes


name: Instruct parents to rub soft toys on infant's body


name: Instruct parents to encourage infant to feel different textures and identify them for infant


name: Instruct parents to blow air in circles on alert infant's arms, legs, and tummy


name: Instruct parents to encourage infant to grasp soft toys or caregiver's fingers


name: Instruct parents to promote shaking of rattles, encouraging auditory following of sounds


name: Instruct parents to provide opportunities for infant to reach for objects


name: Instruct parents to encourage visual following of objects


name: Instruct parents to reposition infant every hour unless sleeping, by placing in infant seat, swing, stroller, as appropriate


name: Instruct parents to place infant on tummy while awake to encourage head lifting


name: Instruct parents to position infant on back under cradle gym


name: Instruct parents to play peek-a-boo with infant


name: Instruct parents to encourage infant to look in mirror


name: Instruct parents to place infant on tummy, putting caregiver's palms on soles of infant's feet and pushing gently forward


name: Instruct parents to stand infant on caregiver's lap, swaying side to side


name: Instruct parents to encourage infant to lie on back and kick with feet


name: Instruct parents to lay infant on back or tummy and help to roll over


name: Instruct parents to provide opportunity for infant to explore cloth or soft plastic books


name: Instruct parents to introduce infant to body parts


name: Instruct parents to encourage infant to use toys for teething


name: Instruct parents to play pat-a-cake with infant


name: Instruct parents to play hide-and-seek with infant


name: Instruct parents to encourage infant to bang toys together


name: Instruct parents to encourage hand transfer of toys


name: Instruct parents to place infant in high chair, encouraging infant to feel food and feed self


name: Instruct parents to dance with infant while holding infant upright


name: Instruct parents to pull infant to standing, holding onto hands for stabilization


name: Instruct parents to guide infant to walk holding infant by hands/wrists with arms above head


name: Instruct parents to encourage ball play (e.g., rolling, grasping, stopping, retrieving)


name: Instruct parents to introduce use of cup at meal times, assisting infant to grasp and put to mouth


name: Instruct parents to wave bye-bye to infant while encouraging infant to imitate


name: Instruct parents to take infant on a house tour, identifying objects and rooms


name: Instruct parents to play follow-the-leader, practicing imitation of infant noises, animals, or songs


name: Instruct parents to say words to infant, encouraging infant to say them back


name: Instruct parents to demonstrate how to remove and replace objects from a container


name: Instruct parents to demonstrate stacking objects


name: Inform the patient and family of the scheduled date, time, and location of surgery


name: Inform the patient and family how long the surgery is expected to last


name: Determine the patient's previous surgical experiences, background, culture, and level of knowledge related to surgery


name: Appraise the patient's and family's anxiety relating to surgery


name: Inform the family of the location to wait for the results of the surgery, as appropriate


name: Conduct a tour of the postsurgical unit and waiting area, as appropriate


name: Describe the postoperative routines and equipment (e.g., medications, respiratory treatments, tubes, machines, support hose, surgical dressings, ambulation, diet, family visitation) and explain their purpose


name: Evaluate the patient's ability to demonstrate splinting incision, coughing, and deep breathing


name: Evaluate the patient's ability to demonstrate proper use of the incentive spirometer


name: Evaluate the patient's ability to demonstrate leg exercises


name: Inform the patient how to assist in recuperation


name: Instruct patient in regard to smoking cessation, as appropriate


name: Instruct in a way that matches the patient's style of learning, including the use of holistic approaches and educational materials, as appropriate


name: Document teaching, including patient's response to teaching


name: Appraise the patient's current and past eating patterns as well as preferred foods and current eating habits


name: Determine the patient's and family's perspectives, cultural backgrounds, and other factors that may affect the patient's willingness to follow prescribed diet


name: Determine any financial limitations that may affect food purchases


name: Explain the purpose of diet adherence to overall health


name: Reinforce the importance of continued monitoring and changing needs that may require further alteration of dietary plan of care


name: Refer patient to dietitian, as appropriate


name: Monitor the patient for physiological and psychological limitations, as well as background and culture


name: Assist the patient in setting goals for slow, steady increase in exercise


name: Instruct patient regarding use of pain medication and alternative methods of pain control before exercise, as needed


name: Instruct patient to report signs of possible problems, (e.g., pain, dizziness, and swelling) to health care provider


name: Assist the patient to incorporate exercise regimen into daily routine


name: Refer the patient to physical therapist, occupational therapist, or exercise physiologist, as appropriate


name: Provide written information or diagrams for continued reference


name: Provide frequent feedback to prevent bad habits from forming


name: Instruct the patient on possible adverse side effects of each medication


name: Instruct patients on proper disposal of needles and syringes at home, as appropriate, and where to dispose of the sharps container in their community


name: Provide the patient with written information about the action, purpose, side effects, and so on of medications


name: Instruct the patient to carry documentation of his or her prescribed medication regimen


name: Instruct the patient how to fill his or her prescription(s), as appropriate


name: Inform the patient/significant other(s) about who will be performing the procedure/treatment


name: Involve child in procedure (hold bandage) but don't give a choice about completing procedure


name: Inform patients on how they can aid in recuperation


name: Provide distraction for child that will divert attention away from procedure


name: Provide information on when and where results will be available and who will explain them


name: Establish level of patient ability in performing skill


name: Adjust teaching methodology to accommodate patient age and ability, as needed


name: Guide patients' bodies so that they can experience the physical sensations that accompany the correct motions, as appropriate


name: Provide frequent feedback to patients on what they are doing correctly and incorrectly, so that bad habits are not formed


name: Obtain sexual history, including number of past sexual partners, frequency of intercourse, and past occurrences of and treatments for sexually transmitted infections (STIs)


name: Instruct patient on anatomy and physiology of human reproduction


name: Instruct patient on STI and conception, as necessary


name: Instruct patient on factors that increase risk of STI (e.g., unprotected sexual intercourse, increased genital mucosal surface area, increased number of sexual contacts, presence of genital sores, advanced illness, and sexual intercourse during menstruation)


name: Discuss patient's knowledge, understanding, motivation, and commitment level regarding various sexual protection methods


name: Discuss methods of sexual protection for sexual intercourse and oral sex (e.g., medication-free, barrier, vaccination, hormonal, intrauterine device, abstinence, and sterilization), including effectiveness, side effects, contraindications, and signs and symptoms that warrant reporting to a health care professional


name: Discuss religious, cultural, developmental, socioeconomical, and individual considerations pertaining to sexual protection choice


name: Provide accurate information pertaining to the implications of having multiple sexual partners


name: Instruct patient on the importance of good hygiene, using a water-soluble lubricant, and voiding after intercourse to decrease the susceptibility to infections


name: Instruct patient on proper use of condoms (e.g., how to choose, keep intact, apply, and remove)


name: Provide patient with sexual protection products (e.g., condoms and dental dams)


name: Encourage patient to obtain routine examinations and report signs and symptoms of STIs to a health care provider


name: Encourage patient to discuss sexual histories and safe sex practices with partner


name: Discuss with patient importance of sexual partner notification when diagnosed with STI


name: Consider population-based factors affecting safe sex education (e.g., culturally tailored interventions, ethnically matched providers)


name: Use social networks (e.g., Internet, phone) to reach marginalized or geographically isolated populations


name: Use appropriate questions to assist the child and adolescent to reflect on what is important personally


name: Educate about sexually transmitted diseases and AIDS


name: Inform about effective contraceptives, as appropriate


name: Instruct accessibility of contraceptives and how to obtain them


name: Assist in choosing an appropriate contraceptive, as appropriate


name: Discuss how aging changes (e.g., medications, medical conditions, chronic illness) may affect sexual desires and actions, as appropriate


name: Identify helpful resources on the Internet provided by responsible organizations (e.g., Center for Parent Education and Resources, Health World Education, National Association of School Nurses, Planned Parenthood of Northern New England)


name: Instruct parent/caregiver to discontinue bottle feeding


name: Instruct parent/caregiver to offer textured solids


name: Instruct parent/caregiver to continue use of spoon and self-feeding


name: Instruct parent/caregiver to introduce dairy products


name: Instruct parent/caregiver to provide healthy snacks


name: Instruct parent/caregiver to offer small portions and frequent feedings


name: Instruct parent/caregiver to avoid "diet" food/drinks (e.g., nonfat milk, diet soda)


name: Instruct parent/caregiver to avoid force feeding as there is decreased appetite


name: Instruct parent/caregiver to encourage drinking water for thirst


name: Instruct parent/caregiver to limit fluids before meals


name: Instruct parent/caregiver to offer foods high in iron and protein


name: Instruct parent/caregiver to have regular mealtimes and eat as a family


name: Instruct parent/caregiver to increase or decrease foods, as appropriate


name: Instruct parent/caregiver to read the labels for nutritive content


name: Instruct parent/caregiver to give child healthy food choices


name: Instruct parent/caregiver to encourage raw/cooked vegetables


name: Instruct parent/caregiver to provide healthy snacks between meals


name: Instruct parent/caregiver to be creative in food preparation for picky eater


name: Instruct parent/caregiver to offer small portions of food


name: Instruct parent/caregiver to limit fat content in foods


name: Instruct parent/caregiver to have child participate in food preparation


name: Instruct parent/caregiver to offer iron-fortified cereals, avoiding high-sugar cereals


name: Instruct parent/caregiver to increase protein foods


name: Instruct parent/caregiver to include all food groups


name: Instruct parent/caregiver to avoid use of food as rewards


name: Instruct parent/caregiver to supervise child outdoors


name: Instruct parent/caregiver to educate child about dangers of throwing and hitting


name: Instruct parent/caregiver to prevent access to electrical outlets, cords, and electrical equipment/appliances/tools


name: Instruct parent/caregiver to store weapons and weapon-like items under lock and key


name: Instruct parent/caregiver to educate child about safe ways of interacting with pets


name: Instruct parent/caregiver to secure doors/gates to prevent child's access to dangerous areas (e.g., street, driveway, pool)


name: Instruct parent/caregiver to dispose of and/or remove the doors to unused refrigerators, ice chests, and other air-tight containers


name: Instruct parent/caregiver to use back burners of the stove, install knob covers, and/or restrict child's access to kitchen


name: Instruct parent/caregiver to set home water heater temperature to between 120 degrees and 130 degrees Fahrenheit


name: Instruct parent/caregiver to install car seat and use it according to manufacturer's recommendations


name: Instruct parent/caregiver to store sharp objects, appliances, and kitchen items out of child's reach


name: Instruct parent/caregiver to instruct child on dangers of the street


name: Instruct parent/caregiver to store all cleaning supplies, medications, and personal care products out of child's reach


name: Instruct parent/caregiver to instruct child on dangers of weapons


name: Instruct parent/caregiver to provide supervision and instruct about safe use of large climbing and riding toys


name: Instruct parent/caregiver to store matches/lighters out of child's reach and instruct child about the dangers of fire and fire starters


name: Instruct parent/caregiver to always supervise child around swimming pools, ponds, and hot tubs


name: Instruct parent/caregiver to instruct child about stranger danger and good touch/bad touch


name: Instruct parent/caregiver to provide an approved helmet for bike riding and instruct child to always wear it


name: Instruct parent/caregiver to prevent child's access to upper story windows, balconies, and stairs


name: Instruct parent/caregiver to closely supervise child when out in public settings


name: Instruct parent/caregiver to instruct child how to get adult help when he or she feels scared or in danger


name: Instruct parent about how to determine the child's physical readiness for toilet training (e.g., child is at least 18 to 24 months of age; shows evidence of being able to hold urine before void; recognizes urge to go or that he or she has just voided or defecated; shows some regularity in elimination patterns; is able to navigate to the toilet/potty, sit on it, and get off when completed; is able to remove and replace clothing before and after elimination; is able to wipe self and wash hands after elimination)


name: Instruct parent about how to determine the child's psychosocial readiness for toilet training (e.g., child expresses interest in and desire to participate/cooperate in toileting; has vocabulary to communicate need to eliminate; is anxious to please parents; imitates the behaviors of others)


name: Instruct parent about how to determine parental/family readiness for toilet training: (e.g., parent has knowledge and time to devote to training process; parent/family is experiencing no major transitions during or shortly after the process such as change of job or residence, divorce, birth of another child; has realistic expectations about child development and the time and energy needed to successfully complete the process; understands child may regress during times of stress or illness)


name: Provide information on strategies to promote toilet training


name: Provide information on how to dress the child in loose, easy-to-remove clothing


name: Provide information on how to agree on vocabulary to be used during training process


name: Provide information on opportunities for child to observe others during the toileting process


name: Provide information on how to take the child to the potty to introduce him or her to the equipment and process


name: Provide information on how to take the child to the potty on a regular basis and encourage him or her to sit


name: Provide information on how to reinforce the child's success with any part of the process


name: Provide information on how to consider the child's temperament or behavior style when planning strategies


name: Provide information on how to expect and ignore accidents


name: Provide information on how to communicate strategies, expectations, and progress to other care providers


name: Consult with other health care team members and recommend equipment or devices for patient use


name: Verify patient data downloaded from biomedical devices to electronic health record


name: Integrate clinical decision support to notify and remind caregiver of clinical abnormal and potential risks


name: Display clinical summaries and trend analysis of pertinent patient-related data


name: Calculate scores from valid and reliable health care assessment instruments


name: Become knowledgeable of the equipment and proficient in using it


name: Instruct patient and family how to operate equipment, as appropriate


name: Inform the patient and family of the expected patient outcomes and side effects associated with using the equipment


name: Consider cultural and socioeconomic barriers to patient's response


name: Obtain information about purpose of the call (e.g., medical diagnoses, if any; past health history; and current treatment regimen)


name: Inquire about related complaints/symptoms, according to standard protocol, if available


name: Obtain data related to effectiveness of current treatment(s), if any, by consulting and citing approved references as sources (e.g., "American Red Cross suggests . . .")


name: Provide clear instruction on how to access needed care, if concerns are acute


name: Make recommendations about regimen changes, as appropriate (using established guidelines, if available)


name: Involve family/significant other(s) in the care and planning


name: Document any assessments, advice, instructions, or other information given to patient, according to specified guidelines


name: Follow guidelines for investigating or reporting suspected child, geriatric, or spousal abuse situations


name: Determine that you are actually speaking to the patient or, if someone else, that you have the patient's permission to give information to that person


name: Use intermediary services such as language relay services, TTY/TDD (teletypewriter/telecommunications device for the deaf), or emerging telecommunication technologies such as computer networks or visual displays, as appropriate


name: Do not leave follow-up messages on answering machines or voice mail to ensure confidentiality


name: Wrap a low birthweight infant in plastic (e.g., polyethylene, polyurethane) immediately after birth while still covered with amniotic fluid, as appropriate and according to agency protocol


name: Maintain humidity at 50% or greater in incubator to reduce evaporative heat loss


name: Prewarm items (e.g., blankets, snugglies) placed next to infant in incubator


name: Inform patient of indications of heat exhaustion and appropriate emergency treatment, as appropriate


name: Inform patient about indications of hypothermia and appropriate emergency treatment, as appropriate


name: Use a warming mattress, warm blankets, and warm ambient environment to raise body temperature, as appropriate


name: Use a cooling mattress, water-circulating blankets, tepid baths, ice-pack or gel-pad application, and intravascular cooling catheterization to lower body temperature, as appropriate


name: Adjust environmental temperature to patient needs


name: Preserve normothermia in newly deceased patients who are organ donors by increasing temperature of ambient air, use of infrared warming lights, warm air or water blankets, or instillation of warmed IV fluids, as appropriate


name: Identify and discuss type of anesthesia planned for patient with surgical team


name: Identify patient risk factors for experiencing abnormalities in body temperature (e.g., general or major regional anesthesia, age, major trauma, burns, low body weight, personal or familial risk for malignant hyperthermia)


name: Prewarm the patient with active warming device (e.g., forced-air warming) for at least 15 minutes before start of anesthesia, as appropriate


name: Transport patient using warming device (e.g., heated isolette), as appropriate


name: Apply and regulate active warming device (e.g., forced-air warming)


name: Adjust ambient room temperature to minimize the risk of hypothermia (i.e., in addition to forced-air warming, when large surface areas are exposed, maintain room temperature at or above 73.4 degrees Fahrenheit or 23 degrees Celsius)


name: Minimize exposure of patient during surgical prepping and procedure, when possible


name: Provide warm or cool irrigating solutions, as appropriate


name: Monitor the temperature of irrigating solutions


name: Warm or cool intravenous fluids, as appropriate


name: Provide or assist in provision of heated, humidified anesthetic gases, as appropriate


name: Provide heated intraperitoneal gases (e.g., carbon dioxide) for laparoscopy


name: Discontinue active warming activities (e.g., forced air warming), when appropriate


name: Monitor vital signs, including continuous core body temperature


name: Monitor for abnormal or unintentional increases or decreases in body temperature


name: Monitor expired carbon dioxide (capnography)


name: Monitor laboratory results (e.g., arterial blood gases, electrolytes)


name: Ensure active warming equipment and supplies are in place and in good working order


name: Maintain emergency equipment and supplies for malignant hyperthermia, per protocol, including dantrolene sodium, in perioperative and perianesthesia areas


name: Initiate malignant hyperthermia protocol, as appropriate


name: Provide handoff communication regarding patient risk of abnormalities in temperature (e.g., personal or familial risk for malignant hyperthermia)


name: Ensure proper body temperature until patient is awake and alert


name: Provide real or simulated hospital operating-room medical equipment to encourage expression of knowledge and feelings about hospitalization, treatments, or illness


name: Identify child's misconceptions or fears through comments made during hospital role-play session


name: Create a comfortable environment without distractions


name: Determine willingness to experience the intervention


name: Place patient in either a comfortable sitting or supine position


name: Place hands with palms facing the patient 3 to 5 inches from the patient's body


name: Begin the 1- to 2-minute assessment by moving the hands slowly and steadily over as much of the patient as possible, from head to toe and front to back


name: Move the hands in very gentle downward movements through the patient's energy field, thinking of the patient as a unitary whole and facilitating an open and balanced energy flow


name: Note the overall pattern of the energy flow, especially any areas of disturbance such as congestion or unevenness, which may be perceived through very subtle cues in the hands (e.g., temperature change, tingling, or other subtle feelings of movement)


name: Finish when it is judged that the appropriate amount of change has taken place (i.e., for an infant, 1-2 minutes; for an adult, 5-10 minutes), keeping in mind the importance of gentleness


name: Encourage the patient to rest for 20 minutes or more after treatment


name: Determine the purpose of the group (e.g., maintenance of reality testing, facilitation of communication, examination of interpersonal skills, and support) and the nature of the group process


name: Create specific group rules and guidelines (e.g., confidentiality, respectful communication and behavior, attendance, socialization of members outside the group, participation) to ensure that all members are compliant


name: Provide a manual that includes the group rules and guidelines for all group members


name: Give the group a sense of direction that enables them to identify and resolve each step of development


name: Use the technique of "here-and-now activation" to move the focus from the generic to the personal, from the abstract to the specific


name: Provide social reinforcement (e.g., verbal and nonverbal) for desired behaviors/responses


name: Obtain history of present illness and medical history


name: Perform physical examination (e.g., general appearance, heart rate, blood pressure, respiratory rate, temperature, pain level, height, and weight)


name: Explain all procedures to the patient and significant other(s)


name: Allow significant other(s) at patient's bedside, if possible


name: Obtain pulse oximetry and apply oxygen, as appropriate


name: Perform targeted assessment of the system that is indicated by the history of present illness


name: Initiate intravenous line and obtain blood samples for laboratory tests


name: Obtain stat computerized tomography head scan, as appropriate


name: Consider guidelines for candidacy (e.g., therapy inclusion and exclusion criteria)


name: Determine whether the patient will receive the therapy


name: Prepare for thrombolytic therapy, if indicated


name: Obtain additional intravenous access site


name: Avoid arterial sampling to prevent bleeding complications


name: Prepare thrombolytic agents, per facility protocol


name: Administer thrombolytic agents, according to specific guidelines for administration


name: Administer additional medications, as ordered


name: Continually monitor cardiac rhythm, vital signs, level of pain, heart and lung sounds, level of consciousness, peripheral perfusion, intake and output, change in neurological status, and resolution of symptoms, as indicated


name: Obtain additional radiological tests (e.g., chest x-ray), as indicated


name: Prepare to initiate basic and advanced life support measures, if indicated


name: Prepare to transfer for definitive care (e.g., cardiac catheterization lab, ICU)


name: Assure placement of proper intravenous line related to duration of nutrients to be infused (e.g., centrally placed line preferred; peripheral lines only in well nourished individuals expecting to need TPN for less than 2 weeks)


name: Use central lines only for infusion of high caloric nutrients or hyperosmolar solutions (e.g., 10% dextrose, 2% amino acids with standard additives)


name: Assure TPN solutions infused in a noncentral catheter are limited to osmolarity less than 900 mOsm/L


name: Insert peripheral intravenous central catheter, per agency protocol


name: Ascertain correct placement of intravenous central catheter by x-ray examination


name: Monitor for infiltration, infection, and metabolic complications (e.g., hyperlipidemia, elevated triglycerides, thrombocytopenia, platelet dysfunction)


name: Provide regular, aseptic, and meticulous care of the central venous catheter, particularly the catheter exit site, to assure prolonged, safe, and complication-free use


name: Avoid use of the catheter for purposes other than delivery of TPN (e.g., blood transfusions and blood sampling)


name: Avoid rapid replacement of TPN solution when interrupted for supplemental infusions


name: Monitor serum albumin, total protein, electrolyte, lipid profiles, glucose levels, and chemistry profile


name: Maintain a small oral nutritional intake during TPN, whenever possible


name: Encourage a gradual transition from parenteral to enteral feeding, if indicated


name: Report abnormal signs and symptoms associated with TPN to the physician and modify care accordingly


name: Instruct patient and family about care of and indications for TPN


name: Assure patient and family comprehension and competency before discharge home with ongoing TPN


name: Evaluate one's own personal comfort in using touch with patients and family members


name: Evaluate the readiness of the patient when offering touch


name: Evaluate the environmental context before offering touch


name: Determine which body part is best to touch and the length of touch that produces the most positive responses in the recipient


name: Provide oral stimulation exercises before tube feedings in premature infants


name: Ensure that the ropes and pulleys are working properly and hang freely off the floor


name: Monitor traction system at least once per shift


name: Remove skin traction devices at least daily for skin inspection and cleansing of skin


name: Perform pin insertion site care at least daily


name: Monitor for body image disturbances and need for counseling


name: Discuss the rationale for, limits, and potential problems of TENS with the patient and family


name: Do not use TENS if the patient has a pacemaker


name: Discuss therapy with provider and obtain prescription for TENS, if appropriate


name: Verify that the TENS unit has full battery charge


name: Inspect the wires for first signs of wear, replacing wires, as needed


name: Select stimulation site, considering alternate sites when direct application is not possible (e.g., adjacent to, distal to, bracketing the site, between affected areas and the brain, and contralateral to the pain)


name: Apply disposable or reusable electrodes to the site of stimulation


name: Apply wires to electrodes and TENS unit, making sure wires are securely plugged into connections


name: Adjust the amplitude, rate, and pulse width to predetermined settings indicated


name: Maintain stimulation for predetermined interval (e.g., continuous or intermittent)


name: Secure TENS unit to the patient (e.g., on patient's belt or waistband of pants), if continuous application is necessary


name: Discontinue use when sensation is strong yet tolerable


name: Adjust the site and settings to achieve the desired response based on individual tolerance


name: Inspect sites of electrodes for possible skin irritation at every application or at least every 12 hours


name: Provide verbal and written instruction on the use of TENS and its operation


name: Determine mobility level and limitations of movement


name: Determine level of consciousness and ability to cooperate


name: Discuss need for relocation with patient and/or family


name: Discuss with patient and helpers how the move will be done


name: Adjust equipment to working heights and lock all wheels, as needed


name: Raise side rail on opposite side of nurse to prevent patient from falling out of bed


name: Raise and move patient with hydraulic lift, as necessary


name: Move patient using transfer board, as necessary


name: Evaluate patient at end of transfer for proper body alignment, nonocclusion of tubes, wrinkle-free linens, unnecessarily exposed skin, adequate patient level of comfort, raised side rails, and call bell within reach


name: Assure that a medical screening examination has been performed and documented


name: Assure that the patient has been stabilized within the capabilities of the transferring facility or has met the conditions under which unstable patients may be transferred under the Emergency Treatment and Labor Act (EMTALA)


name: Determine need for transfer of patient, ensuring that the patient requires treatment at the receiving facility and the benefits of the transfer outweigh the risks


name: Obtain written order from physician to transport patient


name: Identify preference of patient or significant other(s) for receiving facility and physician, as appropriate


name: Document that the receiving facility will accept the patient and has the necessary equipment and staff to handle the clinical situation


name: Obtain written consent for transfer from patient or significant other(s)


name: Obtain written consent for transfer of minors, as appropriate


name: Obtain written consent for release of patient information to receiving facility


name: Facilitate the contact of receiving physician by attending physician, as indicated per EMTALA laws, and document this contact


name: Provide a nurse-to-nurse clinical report about the patient to the receiving facility and document this contact


name: Mobilize and provide necessary personnel, transfer equipment, and pharmaceuticals


name: Copy medical records for receiving facility, including current record of events


name: Assure that the medical records accompany the patient to the receiving facility


name: Complete the certification for transfer that is signed, timed, and dated by the physician


name: Document the medical reason for transfer, as well as the medical benefits and risks of the transfer, as indicated per EMTALA laws


name: Document all information pertaining to patients refusing transfer


name: Attempt to secure written statement of refusal to transfer from patient, if indicated


name: Continue to treat patients refusing transfer within the capability of the facility


name: Facilitate pretransport coordination and communication


name: Obtain physician order before transport, as appropriate


name: Provide appropriate personnel to assist in transport


name: Provide appropriate equipment to assist in transport


name: Discuss need for relocation with patient and significant other(s)


name: Move patient using required equipment, as necessary


name: Monitor, as appropriate, during transport


name: Document pertinent information related to transport


name: Evacuate patients in emergencies such as fire, hurricane, or tornado according to agency disaster plan


name: Teach specific stress-management techniques before trauma exploration to restore a sense of control over thoughts and feelings


name: Involve the parents or caretakers in therapy, as appropriate


name: Educate the parents about their child's response to the trauma and to the process of therapy


name: Assist child in reestablishing a sense of security and predictability in his or her life


name: Monitor for and treat life-threatening injuries or acute needs


name: Attach appropriate identification, as indicated by patient's status


name: Assist with performance of diagnostic tests, as indicated by the patient's condition


name: Refer nonurgent patients to clinics, other primary care providers, or health department


name: Display willingness to help (e.g., "How may I help?")


name: Direct, facilitate, and calm caller by giving simple instructions for action, as needed


name: Prioritize reported symptoms, determining those with highest possible risk first


name: Provide first-aid instructions or emergency directions for crises (e.g., CPR instructions or birthing), using standard guidelines


name: Follow up to determine disposition; document disposition and patient's intended action, as necessary


name: Determine patient's desire and preference for truth in the situation


name: Consult with the patient's family before telling the truth, as culturally appropriate


name: Prepare patients for truth telling by encouraging them to invite family or significant other(s) to be present


name: Remain with the patient to whom you have told the truth and be prepared to clarify, support, and receive feedback


name: Monitor the patient's and family's responses to the interaction, including alterations in pain, restlessness, anxiety, mood change, involvement in care, ability to synthesize new information, ability to verbalize feelings, and reported satisfaction with care, as appropriate


name: Determine indication for the indwelling tube or catheter


name: Use automatic stop orders and reminders to request an order to remove the device when the indication is resolved


name: Maintain proper hand hygiene before, during, and after tube insertion or manipulation


name: Maintain patency of tube, as indicated by tube type and manufacturer directions


name: Secure tubing to prevent pressure and accidental removal


name: Monitor patency of catheter and tube drainage device or system, noting any difficulty in drainage


name: Empty the collection appliance, according to organizational policy, patient condition, and manufacturer instructions


name: Assure functioning of tube and associated equipment


name: Connect tube to suction or proper drainage device, as appropriate


name: Irrigate tube to ensure patency, according to organizational policy, patient condition, and manufacturer instructions


name: Administer skin care and dressing changes at the tube insertion site, as appropriate


name: Assist the patient in securing tube(s) and drainage devices while walking, sitting, and standing, as appropriate


name: Clamp tubing to facilitate ambulation, if appropriate


name: Instruct patient and family about the purpose of the tube and how to care for it


name: Provide emotional support to deal with long-term use of tubes and external drainage devices, as appropriate


name: Determine indication for the indwelling chest tube (e.g., pneumothorax versus drainage of fluids)


name: Maintain proper hand hygiene before, during, and after chest tube insertion or manipulation


name: Monitor for audible air leaks after insertion, indicating improper insertion of tube requiring additional sutures or repositioning


name: Assure familiarity with chest valve device (e.g., water-seal drainage, drainage valve, or flutter valve) and drainage equipment


name: Follow manufacturer recommendations for care of chest valve device and drainage equipment


name: Monitor for proper functioning of device, correct placement in the pleural space, and tube patency (i.e., respiratory swing or fluid oscillating as patient breathes, either in tube or at the fluid meniscus)


name: Note presence of continuous bubbling during inspiration and expiration, indicating either potential worsening of patient condition or a breach in the closed drainage system


name: Monitor for symptoms of resolving pneumothorax (e.g., decrease in bubbling, respiratory swinging, or tidaling in underwater drainage seal device and tubing)


name: Assess patient experiencing sudden changes in swinging, tidaling, or bubbling for emergent conditions


name: Assure use of one-way drainage device, usually an underwater seal drainage bottle


name: Adhere to the recommended water seal level indicated on the underwater seal drainage bottle (i.e., too little water leads to pneumothorax, too much water results in ineffective drainage or ineffective resolution of pneumothorax)


name: Keep the external water seal drainage container below chest level


name: Clamp chest tubes whenever external water seal drainage container is positioned above chest level for extended periods, assuring clamps are in place for as brief a time as possible


name: Assure nontraumatic chest tube clamps are available for any accidental disconnection or damage to the drainage system or to the tubes (e.g., tape spare set of nontraumatic clamps to head of bed or to wall behind headboard)


name: Assure use of multichamber underwater seal drain devices that provide separate chambers for drainage, water seal, and suction, when indicated by patient condition


name: Document chest tube tidaling, output, and air leaks


name: Document bubbling of the suction chamber of the chest tube drainage system and tidaling in water-seal chamber


name: Perform stripping and milking of tube only when indicated by patient condition (e.g., patient symptomatic and tube occluded), or as ordered by the physician


name: Send questionable tube drainage for culture and sensitivity (e.g., cloudy or purulent drainage or patient with high temperature)


name: Document patient response to cough, deep breath, and turn, including swinging, tidaling, and bubbling in chest tube and drainage system


name: Clean around the tube insertion site, per agency protocol


name: Ensure that chest tube drainage device is maintained in an upright position


name: Change chest tube drainage bottles or multichamber drain devices to avoid overfilling or for infection control purposes, as needed


name: Avoid occluding the drainage bottle or device when still attached to the patient, when changing the bottles or devices


name: Instruct patient and family about proper chest tube care


name: Verify placement with x-ray, per agency protocol


name: Provide nose and mouth care three to four times daily or as needed


name: Initiate and monitor delivery of enteral tube feedings, per agency protocol


name: Assist with or insert umbilical catheter in neonates, as ordered or per protocol (e.g., birthweight greater than 1500 g, shock)


name: Infuse medication and nutrients via umbilical venous line, as ordered or per protocol


name: Avoid administration of any medications into arterial catheter


name: Obtain blood samples as appropriate, taking care to aspirate and flush slowly (1 mL/30 seconds) to prevent excessive fluctuations in arterial pressure


name: Change IV tubing and transducer no more than every 72 hours or per institution recommendations


name: Change tubing for blood or lipids every 24 hours


name: Use a central line maintenance bundle to prevent infections


name: Cleanse connections with alcohol, as needed


name: Stabilize catheter to abdomen using occlusive dressing or other securement device


name: Provide calming support (e.g., pacifier, music, distraction, massage) to patient during procedure, as needed


name: Avoid use of physical restraints whenever possible


name: Document appearance of umbilical site and nurse actions


name: Observe for signs requiring catheter removal (e.g., pulseless leg, darkening of toes, blanching of toes or leg, hypertension, redness around umbilicus, visible clots in catheter)


name: Apply pressure to umbilicus for at least 5 minutes


name: Determine indication for the indwelling urinary catheter


name: Maintain proper hand hygiene before, during, and after catheter insertion or manipulation


name: Maintain a closed, sterile, and unobstructed urinary drainage system


name: Assure placement of drainage bag below level of bladder


name: Avoid tilting urine bags or meters to empty or measure urine output (i.e., preventative measure for ascending contamination)


name: Use urine bags or meters with emptying devices located at the bottom of the device


name: Perform routine meatal care with soap and water during daily bathing


name: Change the urinary catheter at regular intervals, as indicated and per agency protocol